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Reed J, Dong T, Eaton E, Friswold J, Porges J, Al-Kindi SG, Rajagopalan S, Neeland IJ. Continuous glucose monitoring for glycaemic control and cardiovascular risk reduction in patients with type 2 diabetes not on insulin therapy: A clinical trial. Diabetes Obes Metab 2024; 26:2881-2889. [PMID: 38680050 DOI: 10.1111/dom.15608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/29/2024] [Accepted: 04/03/2024] [Indexed: 05/01/2024]
Abstract
AIM To evaluate the impact of the Dexcom G6 continuous glucose monitoring (CGM) device on glycaemic control and cardiometabolic risk in patients with type 2 diabetes mellitus (T2DM) at high cardiovascular risk who are not on insulin therapy. MATERIALS AND METHODS Adults with T2DM with glycated haemoglobin (HbA1c) >7% and body mass index (BMI) ≥30 kg/m2 not using insulin were enrolled in a two-phase cross-over study. In phase 1, CGM data were blinded, and participants performed standard glucose self-monitoring. In phase 2, the CGM data were unblinded, and CGM, demographic and cardiovascular risk factor data were collected through 90 days of follow-up and compared using paired tests. RESULTS Forty-seven participants were included (44% women; 34% Black; mean age 63 years; BMI 37 kg/m2; HbA1c 8.4%; 10-year predicted atherosclerotic cardiovascular disease risk 24.0%). CGM use was associated with a reduction in average glucose (184.0 to 147.2 mg/dl, p < .001), an increase in time in range (57.8 to 82.8%, p < .001) and a trend towards lower glucose variability (26.2 to 23.8%). There were significant reductions in HbA1c, BMI, triglycerides, blood pressure, total cholesterol, diabetes distress and 10-year predicted risk for atherosclerotic cardiovascular disease (p < .05 for all) and an increase in prescriptions for sodium-glucose cotransporter 2 inhibitors (36.2 to 83.0%) and glucagon-like peptide-1 receptor agonists (42.5 to 87.2%, p < .001 for both). CONCLUSIONS Dexcom G6 CGM was associated with improved glycaemic control and cardiometabolic risk in patients with T2DM who were not on insulin. CGM can be a safe and effective tool to improve diabetes management in patients at high risk for adverse cardiovascular outcomes.
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Affiliation(s)
- Joseph Reed
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Tony Dong
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Elke Eaton
- Division of Cardiovascular Medicine, University Hospitals Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Janice Friswold
- Division of Cardiovascular Medicine, University Hospitals Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jodie Porges
- Division of Cardiovascular Medicine, University Hospitals Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Sadeer G Al-Kindi
- Division of Cardiology, Houston Methodist Hospital, Houston, Texas, USA
| | - Sanjay Rajagopalan
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Cardiovascular Medicine, University Hospitals Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Ian J Neeland
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Cardiovascular Medicine, University Hospitals Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Kong SY, Cho MK. Effects of Continuous Glucose Monitoring on Glycemic Control in Type 2 Diabetes: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2024; 12:571. [PMID: 38470682 PMCID: PMC10931178 DOI: 10.3390/healthcare12050571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/26/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
As the prevalence of diabetes is rapidly increasing, the use of continuous glucose monitoring, which is effective in improving glycemic control in type 2 diabetes, is increasing. METHODS Systematic review was performed according to PRISMA criteria. The search was conducted for articles published until 31 May 2023 in PubMed, CINAHL, Cochrane Library, EMBASE, ClinicalKey, etc. The meta-analysis involved the synthesis of effect size; tests of homogeneity and heterogeneity; trim and fill plot; Egger's regression test; and Begg's test for assessing publication bias. RESULTS 491 studies were searched, of which 17 studies that met the selection criteria were analyzed. The overall effect on HbA1c was -0.37 (95% CI, -0.63~-0.11, p < 0.001), with HbA1c decreasing significantly after CGM interventions. Sub-analyses showed that the study was statistically significant in those aged 60 years or older, when rt-CGM was used and when the study was performed in multiple centers. CONCLUSION The results of this study showed that intervention using CGM was effective in reducing HbA1c in type 2 diabetes. The factors identified in this study can be used as guidelines for developing future CGM intervention programs.
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Affiliation(s)
- Seung-Yeon Kong
- Referral Center, Chungbuk National University Hospital, Cheongju 28644, Republic of Korea;
| | - Mi-Kyoung Cho
- Department of Nursing Science, Chungbuk National University, Cheongju 28644, Republic of Korea
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Eysenbach G, Sharma A, Green CR, Norman GJ, Thomas R, Leone K. Glycemic Outcomes and Feature Set Engagement Among Real-Time Continuous Glucose Monitoring Users With Type 1 or Non-Insulin-Treated Type 2 Diabetes: Retrospective Analysis of Real-World Data. JMIR Diabetes 2023; 8:e43991. [PMID: 36602920 PMCID: PMC9947825 DOI: 10.2196/43991] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/15/2022] [Accepted: 01/05/2023] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The benefits of real-time continuous glucose monitoring (RT-CGM) are well established for patients with type 1 diabetes (T1D) and patients with insulin-treated type 2 diabetes (T2D). However, the usage and effectiveness of RT-CGM in the context of non-insulin-treated T2D has not been well studied. OBJECTIVE We aimed to assess glycemic metrics and rates of RT-CGM feature utilization in users with T1D and non-insulin-treated T2D. METHODS We retrospectively analyzed data from 33,685 US-based users of an RT-CGM system (Dexcom G6; Dexcom, Inc) who self-identified as having either T1D (n=26,706) or T2D and not using insulin (n=6979). Data included glucose concentrations, alarm settings, feature usage, and event logs. RESULTS The T1D cohort had lower proportions of glucose values in the 70 mg/dl to 180 mg/dl range than the T2D cohort (52.1% vs 70.8%, respectively), with more values indicating hypoglycemia or hyperglycemia and higher glycemic variability. Discretionary alarms were enabled by a large majority in both cohorts. The data sharing feature was used by 38.7% (10,327/26,706) of those with T1D and 10.4% (727/6979) of those with T2D, and the mean number of followers was higher in the T1D cohort. Large proportions of patients with T1D or T2D enabled and customized their glucose alerts. Retrospective analysis features were used by the majority in both cohorts (T1D: 15,783/26,706, 59.1%; T2D: 3751/6979, 53.8%). CONCLUSIONS Similar to patients with T1D, patients with non-insulin-treated T2D used RT-CGM system features, suggesting beneficial, routine engagement with data by patients and others involved in their care. Motivated patients with diabetes could benefit from RT-CGM coverage.
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Affiliation(s)
| | | | - Courtney R Green
- Department of Medical Affairs, Dexcom, Inc, San Diego, CA, United States
| | - Gregory J Norman
- Department of Global Access, Dexcom, Inc, San Diego, CA, United States
| | - Roy Thomas
- Department of Medical Affairs, Dexcom, Inc, San Diego, CA, United States
| | - Keri Leone
- Department of Medical Affairs, Dexcom, Inc, San Diego, CA, United States
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4
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Smith IP, Whichello CL, Veldwijk J, Rutten-van Mölken MPMH, Groothuis-Oudshoorn CGM, Vos RC, de Bekker-Grob EW, de Wit GA. Diabetes patient preferences for glucose-monitoring technologies: results from a discrete choice experiment in Poland and the Netherlands. BMJ Open Diabetes Res Care 2023; 11:11/1/e003025. [PMID: 36649973 PMCID: PMC9853131 DOI: 10.1136/bmjdrc-2022-003025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 12/10/2022] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION New glucose-monitoring technologies have different cost-benefit profiles compared with traditional finger-prick tests, resulting in a preference-sensitive situation for patients. This study aimed to assess the relative value adults with diabetes assign to device attributes in two countries. RESEARCH DESIGN AND METHODS Adults with type 1 or 2 diabetes from the Netherlands (n=226) and Poland (n=261) completed an online discrete choice experiment. Respondents choose between hypothetical glucose monitors described using seven attributes: precision, effort to check, number of finger pricks required, risk of skin irritation, information provided, alarm function and out-of-pocket costs. Panel mixed logit models were used to determine attribute relative importance and to calculate expected uptake rates and willingness to pay (WTP). RESULTS The most important attribute for both countries was monthly out-of-pocket costs. Polish respondents were more likely than Dutch respondents to choose a glucose-monitoring device over a standard finger prick and had higher WTP for a device. Dutch respondents had higher WTP for device improvements in an effort to check and reduce the number of finger pricks a device requires. CONCLUSION Costs are the primary concern of patients in both countries when choosing a glucose monitor and would likely hamper real-world uptake. The costs-benefit profiles of such devices should be critically reviewed.
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Affiliation(s)
- Ian P Smith
- Healthcare Innovation and Evaluation, University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Chiara L Whichello
- Evidera, London, UK
- Erasmus School of Health Policy and Management, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jorien Veldwijk
- Healthcare Innovation and Evaluation, University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
- Erasmus School of Health Policy and Management, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - C G M Groothuis-Oudshoorn
- Health Technology and Services Research (HTSR), Faculty of Behavioural Management and Social Sciences, University of Twente, Enschede, The Netherlands
| | - Rimke C Vos
- Public Health and Primary Care/LUMC Campus The Hague, Leiden University Medical Center, Leiden, The Netherlands
| | - Esther W de Bekker-Grob
- Erasmus School of Health Policy and Management, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - G Ardine de Wit
- Healthcare Innovation and Evaluation, University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
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van Heerden A, Kolozali Ş, Norris SA. Feasibility and acceptability of continuous at-home glucose monitoring during pregnancy: a mixed-methods pilot study. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2022. [DOI: 10.1080/16070658.2022.2114408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Alastair van Heerden
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
- SAMRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Şefki Kolozali
- School of Computer Science and Electronic Engineering, University of Essex, Essex, United Kingom
| | - Shane A Norris
- SAMRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- School of Health and Human Development, University of Southampton, Southampton, United Kingom
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6
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Chang VYX, Tan YL, Ang WHD, Lau Y. Effects of continuous glucose monitoring on maternal and neonatal outcomes in perinatal women with diabetes: A systematic review and meta-analysis of randomized controlled trials. Diabetes Res Clin Pract 2022; 184:109192. [PMID: 35032563 DOI: 10.1016/j.diabres.2022.109192] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 12/10/2021] [Accepted: 01/04/2022] [Indexed: 11/28/2022]
Abstract
AIMS This systematic review aims to assess the effects of continuous glucose monitoring (CGM) on maternal and neonatal outcomes in perinatal women with diabetes. METHODS A three-step comprehensive search was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline. Randomized controlled trials (RCTs) were retrieved from international databases of PubMed, Embase, Cochrane Library, CINAHL, PsycINFO and Scopus from their respective inception dates until 5th January 2021. Comprehensive Meta-Analysis Software Version 3 was used. The overall effect was determined using Hedges' g. Cochrane collaboration's tool version 1 and grading of recommendations, assessment, development and evaluation criteria were used for quality assessment. RESULTS A total of 1215 records were identified and 10 RCTs involving a total of 1358 perinatal women were selected. The meta-analysis revealed that CGM significantly improved HbA1c levels (g = -0.43, 95% CI: -0.63, -0.22), lowered cesarean section rate (g = -0.17, 95% CI: -0.33, -0.02) and neonatal birth weight (g = -0.16, 95% CI: -0.27, -0.04) when compared to the comparator. The majority (86.67%) has a low risk of biases and certainty of evidence ranged from very low to moderate. CONCLUSION CGM improves maternal and neonatal outcomes. Future studies should use well-designed large-scale trials.
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Affiliation(s)
| | - Yi Ling Tan
- Department of Nursing, Raffles Hospital, Singapore.
| | - Wei How Darryl Ang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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7
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Kompala T, Neinstein AB. Analysis of "Accuracy of a 14-Day Factory Calibrated Continuous Glucose Monitoring System With Advanced Algorithm in Pediatric and Adult Population With Diabetes". J Diabetes Sci Technol 2022; 16:78-80. [PMID: 33084373 PMCID: PMC8875038 DOI: 10.1177/1932296820967004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In this study by Alva et al, accuracy of a second-generation factory calibrated continuous glucose monitoring system is evaluated. Compared to the first-generation FreeStyle Libre 14-day system (FSL), accuracy was improved throughout the 14-day wear period, including improved accuracy in hypoglycemia for adults and youth. The addition of optional real-time alerts for hypoglycemia and hyperglycemia as well as an integrated continuous glucose monitor (iCGM) designation by the FDA may further enable users to benefit from using CGM in real time, including in future automated insulin delivery systems. As CGM accuracy, affordability, and accessibility improve, we anticipate increased uptake of CGM by people on intensive insulin therapy, and also potential benefits and expansion into a broader patient population. There are growing opportunities to leverage cloud-connected CGM devices in the increasingly virtual, continuous telehealth-driven diabetes care model, which will require more focus on development and use of data interoperability standards.
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Affiliation(s)
- Tejaswi Kompala
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Aaron B. Neinstein
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Center for Digital Health Innovation, University of California, San Francisco, San Francisco, CA, USA
- Aaron B. Neinstein, MD, University of California, San Francisco, 1700 Owens Street, Suite 541, San Francisco, CA 94158, USA.
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Wright EE, Subramanian S. Evolving Use of Continuous Glucose Monitoring Beyond Intensive Insulin Treatment. Diabetes Technol Ther 2021; 23:S12-S18. [PMID: 34546082 DOI: 10.1089/dia.2021.0191] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Numerous studies have demonstrated the clinical benefits of continuous glucose monitoring (CGM) use in individuals with type 1 diabetes and type 2 diabetes (T2D) who are treated with intensive insulin therapy. A growing body of evidence suggests that CGM use may also confer similar glycemic benefits in T2D individuals who are treated with less-intensive therapies. Investigators are also exploring the potential use of CGM as an aid in weight management. This article reviews the continuing evolution of CGM, focusing on how CGM may be used to improve glycemic control and promote adoption of desired health behaviors within broader T2D and prediabetes populations.
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Oikonomidi T, Ravaud P, James A, Cosson E, Montori V, Tran VT. An International, Mixed-Methods Study of the Perceived Intrusiveness of Remote Digital Diabetes Monitoring. Mayo Clin Proc 2021; 96:1236-1247. [PMID: 33487438 DOI: 10.1016/j.mayocp.2020.07.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/06/2020] [Accepted: 07/23/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess the relationship between remote digital monitoring (RDM) modalities for diabetes and intrusiveness in patients' lives. PATIENTS AND METHODS Online vignette-based survey (February 1 through July 1, 2019). Adults with diabetes (type 1, 2, or subtypes such as latent autoimmune diabetes of adulthood) assessed three randomly selected vignettes among 36 that combined different modalities for monitoring tools (three options: glucose- and physical activity [PA]-monitoring only, or glucose- and PA-monitoring with occasional or regular food monitoring), duration/feedback loops (six options: monitoring for a week before all vs before specific consultations with feedback given in consultation, vs monitoring permanently, with real-time feedback by one's physician vs by anoter caregiver, vs monitoring permanently, with real-time, artificial intelligence-generated treatment feedback vs treatment and lifestyle feedback), and data handling (two options: by the public vs private sector). We compared intrusiveness (assessed on a 5-point scale) across vignettes and used linear mixed models to identify intrusiveness determinants. We collected qualitative data to identify aspects that drove participants' perception of intrusiveness. RESULTS Overall, 1010 participants from 30 countries provided 2860 vignette-assessments (52% were type 1 diabetes). The monitoring modalities associated with increased intrusiveness were food monitoring compared with glucose- and PA-monitoring alone (β=0.34; 95% CI, 0.26 to 0.42; P<.001) and permanent monitoring with real-time physician-generated feedback compared with monitoring for a week with feedback in consultation (β=0.25; 95% CI, 0.16 to 0.34, P<.001). Public-sector data handling was associated with decreased intrusiveness as compared with private-sector (β=-0.15; 95% CI, -0.22 to -0.09; P<.001). Four drivers of intrusiveness emerged from the qualitative analysis: practical/psychosocial burden (eg, RDM attracting attention in public), control, data safety/misuse, and dehumanization of care. CONCLUSION RDM is intrusive when it includes food monitoring, real-time human feedback, and private-sector data handling.
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Affiliation(s)
- Theodora Oikonomidi
- Université de Paris, CRESS, INSERM, INRA, Paris, France; Clinical Epidemiology Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
| | - Philippe Ravaud
- Université de Paris, CRESS, INSERM, INRA, Paris, France; Clinical Epidemiology Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Arthur James
- Université de Paris, CRESS, INSERM, INRA, Paris, France; Clinical Epidemiology Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emmanuel Cosson
- Sorbonne Paris Nord, Sorbonne Paris Cité, AP-HP, Avicenne Hospital, Department of Endocrinology, CRNH-IdF, CINFO, Bobigny, France; Sorbonne Paris Nord, CRESS, UMR 1153 INSERM/U1125 INRA/CNAM, Unité de Recherche Epidémiologique Nutritionnelle, Bobigny, France
| | - Victor Montori
- Department of Health and Human Services, Center for Evidence and Practice Improvement of the Agency for Healthcare Research and Quality, Rockville, MD; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | - Viet-Thi Tran
- Université de Paris, CRESS, INSERM, INRA, Paris, France; Clinical Epidemiology Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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Bergenstal RM, Layne JE, Zisser H, Gabbay RA, Barleen NA, Lee AA, Majithia AR, Parkin CG, Dixon RF. Remote Application and Use of Real-Time Continuous Glucose Monitoring by Adults with Type 2 Diabetes in a Virtual Diabetes Clinic. Diabetes Technol Ther 2021; 23:128-132. [PMID: 33026839 PMCID: PMC7868574 DOI: 10.1089/dia.2020.0396] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The Onduo Virtual Diabetes Clinic (VDC) for people with type 2 diabetes (T2D) combines a mobile app, remote lifestyle coaching, connected devices, and live video consultations with board-certified endocrinologists. Adults with T2D (n = 594) who were evaluated by a VDC endocrinologist, remotely prescribed and mailed a real-time continuous glucose monitoring (rtCGM) device and used ≥1 sensor completed a CGM satisfaction questionnaire. The CGM satisfaction score was 4.5 ± 0.8 out of 5. Most respondents (94.7%) agreed/strongly agreed that they were comfortable inserting the sensor remotely and that rtCGM use improved understanding of the impact of eating (97.0%), increased diabetes knowledge (95.7%), and helped improve diabetes control when not wearing the sensor (79.4%). HbA1c (n = 372) decreased from 7.7% ± 1.6% to 7.1% ± 1.2% (P < 0.001; 10.2 months). These data suggest that it is feasible to provide rtCGM directly to individuals with T2D through a VDC without in-office training. Intermittent use of rtCGM was well-received by adults with T2D and was associated with improvement in HbA1c.
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Affiliation(s)
- Richard M. Bergenstal
- International Diabetes Center at Park Nicollet, HealthPartners Institute, Minneapolis, Minnesota, USA
| | | | - Howard Zisser
- Verily Life Sciences, South San Francisco, California, USA
| | - Robert A. Gabbay
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Amit R. Majithia
- University of California San Diego, School of Medicine, La Jolla, California, USA
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Oikonomidi T, Ravaud P, Cosson E, Montori V, Tran VT. Evaluation of Patient Willingness to Adopt Remote Digital Monitoring for Diabetes Management. JAMA Netw Open 2021; 4:e2033115. [PMID: 33439263 PMCID: PMC7807289 DOI: 10.1001/jamanetworkopen.2020.33115] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 11/18/2020] [Indexed: 01/21/2023] Open
Abstract
Importance Patients will decide whether to adopt remote digital monitoring (RDM) for diabetes by weighing its health benefits against the inconvenience it may cause. Objective To identify the minimum effectiveness patients report they require to adopt 36 different RDM scenarios. Design, Setting, and Participants This survey study was conducted among adults with type 1 or type 2 diabetes living in 30 countries from February to July 2019. Exposures Survey participants assessed 3 randomly selected scenarios from a total of 36. Scenarios described different combinations of digital monitoring tools (glucose, physical activity, food monitoring), duration and feedback loops (feedback in consultation vs real-time telefeedback by a health care professional or by artificial intelligence), and data handling modalities (by a public vs private company), reflecting different degrees of RDM intrusiveness in patients' personal lives. Main Outcomes and Measures Participants assessed the minimum effectiveness for 2 diabetes-related outcomes (reducing hypoglycemic episodes and preventing ophthalmologic complications) for which they would adopt each RDM (from much less effective to much more effective than their current monitoring). Results Of 1577 individuals who consented to participate, 1010 (64%; 572 [57%] women, median [interquartile range] age, 51 [37-63] years, 524 [52%] with type 1 diabetes) assessed at least 1 vignette. Overall, 2860 vignette assessments were collected. In 1025 vignette assessments (36%), participants would adopt RDM only if it was much more effective at reducing hypoglycemic episodes compared with their current monitoring; in 1835 assessments (65%), participants would adopt RDM if was just as or somewhat more effective. The main factors associated with required effectiveness were food monitoring (β = 0.32; SE, 0.12; P = .009), real-time telefeedback by a health care professional (β = 0.49; SE, 0.15; P = .001), and perceived intrusiveness (β = 0.36; SE, 0.06; P < .001). Minimum required effectiveness varied among participants; 34 of 36 RDM scenarios (94%) were simultaneously required to be just as or less effective by at least 25% of participants and much more effective by at least 25% of participants. Results were similar for participant assessments of scenarios regarding the prevention of ophthalmologic complications. Conclusions and Relevance The findings of this study suggest that patients require greater health benefits to adopt more intrusive RDM modalities, food monitoring, and real-time feedback by a health care professional. Patient monitoring devices should be designed to be minimally intrusive. The variability in patients' requirements points to a need for shared decision-making.
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Affiliation(s)
- Theodora Oikonomidi
- Université de Paris, Centre of Research in Epidemiology and Statistics, French National Institute of Health and Medical Research, National Institute for Agricultural Research, Paris, France
- Clinical Epidemiology Unit, Hôtel-Dieu Hospital, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Philippe Ravaud
- Université de Paris, Centre of Research in Epidemiology and Statistics, French National Institute of Health and Medical Research, National Institute for Agricultural Research, Paris, France
- Clinical Epidemiology Unit, Hôtel-Dieu Hospital, Assistance Publique–Hôpitaux de Paris, Paris, France
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Emmanuel Cosson
- Sorbonne Paris Nord, Sorbonne Paris Cité, Assistance Publique–Hôpitaux de Paris, Avicenne Hospital, Department of Endocrinology, Research Centre in Human Nutrition–Ile de France, North Ile-de-France Integrated Obesity Centre, Bobigny, France
- Sorbonne Paris Nord, Centre of Research in Epidemiology and Statistics, Research Unit 1153, French National Institute of Health and Medical Research, U1125 National Institute for Agricultural Research, National Conservatory of Arts and Crafts, Bobigny, France
| | - Victor Montori
- Department of Health and Human Services, Center for Evidence and Practice Improvement of the Agency for Healthcare Research and Quality, Rockville, Maryland
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
| | - Viet Thi Tran
- Université de Paris, Centre of Research in Epidemiology and Statistics, French National Institute of Health and Medical Research, National Institute for Agricultural Research, Paris, France
- Clinical Epidemiology Unit, Hôtel-Dieu Hospital, Assistance Publique–Hôpitaux de Paris, Paris, France
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12
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Hirsch IB, Nardacci E, Verderese CA. Flash Continuous Glucose Monitoring: Implications for Use of Continuous Data in Daily Diabetes Management. Diabetes Spectr 2019; 32:355-367. [PMID: 31798294 PMCID: PMC6858083 DOI: 10.2337/ds18-0059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Full realization of the benefits of continuous glucose monitoring (CGM) depends on addressing barriers such as cost, accuracy, burdens of daily use, and uncertainty about applying the data. Lack of systematic education has also hampered widespread adoption among patients and health care professionals. This article describes the practical application of an affordable and intuitive category of CGM called "flash" that requires users to scan the sensor with a handheld reader for on-demand access to continuous data. The data may be used for in-the-moment therapy adjustment, retrospective review of glucose patterns, and observation of glucose trending in response to behavior. Higher rates of flash CGM scanning have been associated with increased time in the glycemic target range and reduced time in hyper- and hypoglycemia. Growing interest in this technology suggests new opportunities for helping more patients incorporate CGM into their daily self-care.
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Abstract
IN BRIEF Obstacles to realizing the clinical benefits of continuous glucose monitoring (CGM) for daily diabetes management are being overcome with more affordable, user-friendly technologies. This article describes a novel category of CGM known as "flash" that may allow more routine use of continuous data for greater numbers of patients treated in primary care.
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Affiliation(s)
- Irl B. Hirsch
- University of Washington School of Medicine, Seattle, WA
| | - Eugene E. Wright
- Department of Medicine and Community and Family Medicine, Duke Southern Regional Area Health Education Center, Fayetteville, NC
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Ida S, Kaneko R, Murata K. Utility of Real-Time and Retrospective Continuous Glucose Monitoring in Patients with Type 2 Diabetes Mellitus: A Meta-Analysis of Randomized Controlled Trials. J Diabetes Res 2019; 2019:4684815. [PMID: 30775385 PMCID: PMC6350576 DOI: 10.1155/2019/4684815] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/23/2018] [Accepted: 10/28/2018] [Indexed: 11/17/2022] Open
Abstract
In the present study, we aimed to investigate the effects of continuous glucose monitoring (CGM) on blood glucose levels, body weight, blood pressure, and hypoglycaemia in patients with type 2 diabetes mellitus using a meta-analysis of randomized controlled trials (RCTs). A literature search was performed using MEDLINE, Cochrane Controlled Trials Registry, and ClinicalTrials.gov. RCTs using CGM in patients with type 2 diabetes mellitus were then selected. Statistical analysis included calculation of the standardized mean difference (SMD) or risk ratio and 95% confidence intervals (CIs) using a random effects model. After literature search, seven RCTs (669 patients) satisfied the eligibility criteria established herein and were included into the meta-analysis. Compared with the self-monitoring blood glucose group, the CGM group exhibited significantly lower HbA1c levels (SMD, -0.35; 95% CI, -0.59--0.10; P = 0.006) and shorter time spent with hypoglycaemia (SMD, -0.42; 95% CI, -0.70--0.13; P = 0.004). Conversely, no differences in body weight and blood pressure were observed between the groups. CGM in patients with type 2 diabetes mellitus could reduce HbA1c levels and time spent with hypoglycaemia. However, because few RCTs were included in this present study and heterogeneity was also noted, care should be taken when interpreting the results.
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Affiliation(s)
- Satoshi Ida
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, Mie, Japan
| | - Ryutaro Kaneko
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, Mie, Japan
| | - Kazuya Murata
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, Mie, Japan
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Taylor PJ, Thompson CH, Brinkworth GD. Effectiveness and acceptability of continuous glucose monitoring for type 2 diabetes management: A narrative review. J Diabetes Investig 2018; 9:713-725. [PMID: 29380542 PMCID: PMC6031515 DOI: 10.1111/jdi.12807] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/07/2018] [Accepted: 01/21/2018] [Indexed: 01/05/2023] Open
Abstract
The present narrative review discusses the role of continuous glucose monitoring (CGM) in glycemic and weight control, and lifestyle behavior adherence in adults with type 2 diabetes. A literature search from January 2001 to November 2017 was carried out (MEDLINE, CINAHL, Web of Science and Scopus). Eligible studies were trials evaluating the use of CGM with the aim of achieving glucose control or lifestyle-related treatment adherence over a period of ≥8 weeks in adults with type 2 diabetes compared with usual care or another comparison intervention, or observational trials reporting CGM user experience. A total of 5,542 participants were recruited into 11 studies (eight randomized controlled trials [n = 5,346] and three observational studies [n = 196]). The sample size ranged 6-4,678 participants, the mean age was 51.7-60.0 years and diabetes duration was 2.1-19.2 years, with high heterogeneity between studies. Overall, the available evidence showed, compared with traditional self-monitoring of blood glucose levels, CGM promoted greater reductions in glycated hemoglobin, bodyweight and caloric intake; higher adherence rating to a personal eating plan; and increases in physical activity. High compliance to CGM wear-time and device calibration was reported (>90%). The addition of lifestyle and/or behavioral counseling to CGM appeared to further potentiate these improvements. Preliminary evidence suggests that CGM use promotes glycemic and weight control, and lifestyle behavior adherence in adults with type 2 diabetes. These benefits might be further enhanced with integration of diet, exercise, and glucose excursion education and counseling. However, specific attributes of effective interventions and the application of CGM information for promoting improved outcomes and healthier choices remain unclear.
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Affiliation(s)
- Pennie J Taylor
- CSIRO, Health and BiosecurityAdelaideSouth AustraliaAustralia
- Discipline of MedicineSchool of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Campbell H Thompson
- Discipline of MedicineSchool of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
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Abstract
PURPOSE OF REVIEW Continuous glucose monitoring (CGM) technology has long been accepted as a tool for managing glycemia in type 1 diabetes (T1D) and is receiving increased attention as a tool for monitoring glucose patterns in patients with other forms of diabetes, in particular type 2 diabetes (T2D). Recent studies in adults with T2D have shown benefits of CGM in the investigation of glycemic variability, as well as utility as a tool for improving glycemic control. The literature on CGM use in youth-onset T2D, however, is sparse. This paper reviews the various roles for CGM in T2D, with a focus on published reports of CGM use in youth-onset T2D. The gaps in knowledge are highlighted, along with a discussion regarding need for future studies of potential applications for CGM in this younger population. RECENT FINDINGS CGM systems provide insight into glycemic abnormalities in obese youth with and at risk for T2D. This technology has enabled examination of the relationship between free-living glycemic profiles and traditional diabetes screening tests, as well as markers of cardiometabolic risk in this high-risk population. Investigators are incorporating CGM technology into the study of T2D in youth, but interventional studies of CGM as a tool for glycemic control in youth-onset T2D are limited. Youth with T2D face a more aggressive disease than adults with T2D, and further studies utilizing advances in glucose monitoring technology to improve outcomes in this population are needed.
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Affiliation(s)
- Christine L Chan
- Department of Pediatrics, Endocrinology, University of Colorado School of Medicine, Children's Hospital Colorado, 13123 E. 16th Avenue, Aurora, CO, 80045, USA.
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Özcan B, Leenen PJM, Delhanty PJD, Baldéon-Rojas LY, Neggers SJ, van der Lely AJ. Unacylated ghrelin modulates circulating angiogenic cell number in insulin-resistant states. Diabetol Metab Syndr 2017; 9:43. [PMID: 28572856 PMCID: PMC5452348 DOI: 10.1186/s13098-017-0239-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 05/17/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) is associated with reduced numbers and impaired function of circulating angiogenic cells (CAC) which contributes to the progression of atherosclerosis and microvascular disease. Previous studies suggest that short-term infusion of unacylated ghrelin (UAG) normalizes CAC number in patients with T2D. To determine dose-dependent effects of short-term infusion of UAG in T2D patients using a cross-over model, and of long-term infusion of UAG in obese mice, on differentiation of monocyte progenitors into CAC. METHODS Eight overweight T2D patients were infused overnight with 3 and 10 µg/kg/h of UAG in a double-blind, placebo-controlled cross-over study. To assess the effects of long-term UAG treatment, obese mice were infused with UAG for 4 weeks. Monocyte progenitors were assessed for their ability to differentiate into CAC in vitro. RESULTS In T2D patients, UAG treatment caused a reduction in differentiation of CAC, dependent on UAG dose and differentiation method. However, mice treated with UAG showed a significant increase in differentiation of bone marrow progenitors into CAC. CONCLUSION UAG causes a minor suppressive effect on CAC development after short-term treatment in humans, but experiments in mice suggest that long-term treatment has beneficial effects on CAC formation. The Netherlands Trial Register: TC=2487.
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Affiliation(s)
- Behiye Özcan
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
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Rai S, Hulse A, Kumar P. Feasibility and acceptability of ambulatory glucose profile in children with Type 1 diabetes mellitus: A pilot study. Indian J Endocrinol Metab 2016; 20:790-794. [PMID: 27867881 PMCID: PMC5105562 DOI: 10.4103/2230-8210.192894] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Insulin administration and self-monitoring of blood glucose (SMBG) are pillars in the management of diabetes in children. Introduction of continuous glucose monitoring (CGM) has made it possible to understand the glycemic profiles which are not picked up by SMBG. Recent advent of flash glucose monitoring with inbuilt software to obtain ambulatory glucose profile (AGP) has emerged as a novel method to study glycemic patterns in adults with Type I diabetes. However, the use of AGP in children is yet to be explored. METHODS AGP was used in 46 children with Type 1 diabetes mellitus. Feasibility was measured regarding data and sensor failure. Acceptability was measured using a questionnaire. RESULTS Forty-six children (22 girls and 24 boys) with a mean age of 10.07 years and mean diabetes duration of 3.4 years were included in the study. In this cohort, for 30 (65.21%) subjects, the sensor remained in situ for a complete duration of 14 days. Except for minor discomfort, AGP was well accepted by most of the children and their parents. CONCLUSION AGP is a feasible option for monitoring glycemic status in children with diabetes with a high rate of acceptance.
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Affiliation(s)
- Sushma Rai
- Department of Pediatrics, PESIMSR, Kuppam, Andhra Pradesh, India
- Department of Diabetes and Endocrinology, Bangalore Diabetes Hospital, Bengaluru, Karnataka, India
| | - Anjana Hulse
- Department of Diabetes and Endocrinology, Bangalore Diabetes Hospital, Bengaluru, Karnataka, India
| | - Prasanna Kumar
- Department of Diabetes and Endocrinology, Bangalore Diabetes Hospital, Bengaluru, Karnataka, India
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Abstract
Real-time continuous glucose monitoring (RT-CGM) has, in the span of just a few years, established an essential role in the contemporary management of type 1 diabetes. Nonetheless, masked CGM retains an important place in the management of diabetes including assisting with hypoglycemia detection and avoidance, optimizing glycemic control, and acting as a teaching tool for people living with diabetes.
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Affiliation(s)
- Ian Blumer
- Charles H. Best Diabetes Centre, Ajax, ON, Canada University of Toronto, 27 King's College Cir, Toronto, ON, Canada
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Sato J, Kanazawa A, Ikeda F, Shigihara N, Kawaguchi M, Komiya K, Uchida T, Ogihara T, Mita T, Shimizu T, Fujitani Y, Watada H. Effect of treatment guidance using a retrospective continuous glucose monitoring system on glycaemic control in outpatients with type 2 diabetes mellitus: A randomized controlled trial. J Int Med Res 2015; 44:109-21. [PMID: 26647072 PMCID: PMC5536570 DOI: 10.1177/0300060515600190] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 07/22/2015] [Indexed: 11/17/2022] Open
Abstract
Objectives To assess the effect of treatment guidance based on data from a continuous glucose monitoring (CGM) device on glycaemic control, and patient satisfaction, in patients with type 2 diabetes mellitus (T2DM). Methods Patients with poorly-controlled T2DM treated with insulin were randomly assigned to the intervention or nonintervention group. Continuous blood-glucose levels were recorded for 4–5 days using a CGM device on three separate occasions during the 8-month study period. The intervention group received treatment guidance based on the CGM data; the nonintervention group received advice based on blood glucose and glycosylated haemoglobin (HbA1c) levels. Results A total of 34 patients were enrolled in the study. The mean ± SD baseline HbA1c was 8.2 ± 1.2% in the intervention group and 8.2 ± 0.9% in the nonintervention group. At the study end, there was no significant difference in the change from baseline of HbA1c between the two groups. There was also no significant difference in the change from baseline in the Diabetes Treatment Satisfaction Questionnaire score between the two groups. Conclusions The present study did not demonstrate that treatment guidance using retrospective CGM data was effective for improving glycaemic control and therapeutic satisfaction in Japanese patients with T2DM.
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Affiliation(s)
- Junko Sato
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akio Kanazawa
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan Centre for Therapeutic Innovations in Diabetes, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Fuki Ikeda
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nayumi Shigihara
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Minako Kawaguchi
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Koji Komiya
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Toyoyoshi Uchida
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takeshi Ogihara
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomoya Mita
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomoaki Shimizu
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yoshio Fujitani
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hirotaka Watada
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan Centre for Therapeutic Innovations in Diabetes, Juntendo University Graduate School of Medicine, Tokyo, Japan Centre for Molecular Diabetology, Juntendo University Graduate School of Medicine, Tokyo, Japan Sportology Centre, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Özcan B, Neggers SJCMM, Miller AR, Yang HC, Lucaites V, Abribat T, Allas S, Huisman M, Visser JA, Themmen APN, Sijbrands EJG, Delhanty PJD, van der Lely AJ. Does des-acyl ghrelin improve glycemic control in obese diabetic subjects by decreasing acylated ghrelin levels? Eur J Endocrinol 2014; 170:799-807. [PMID: 23864339 DOI: 10.1530/eje-13-0347] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The objective of this study was to assess the effects of a continuous overnight infusion of des-acyl ghrelin (DAG) on acylated ghrelin (AG) levels and glucose and insulin responses to a standard breakfast meal (SBM) in eight overweight patients with type 2 diabetes. Furthermore, in the same patients and two additional subjects, the effects of DAG infusion on AG concentrations and insulin sensitivity during a hyperinsulinemic-euglycemic clamp (HEC) were assessed. RESEARCH DESIGN AND METHODS A double-blind, placebo-controlled cross-over study design was implemented, using overnight continuous infusions of 3 and 10 μg DAG/kg per h and placebo to study the effects on a SBM. During a HEC, we studied the insulin sensitivity. RESULTS We observed that, compared with placebo, overnight DAG administration significantly decreased postprandial glucose levels, both during continuous glucose monitoring and at peak serum glucose levels. The degree of improvement in glycemia was correlated with baseline plasma AG concentrations. Concurrently, DAG infusion significantly decreased fasting and postprandial AG levels. During the HEC, 2.5 h of DAG infusion markedly decreased AG levels, and the M-index, a measure of insulin sensitivity, was significantly improved in the six subjects in whom we were able to attain steady-state euglycemia. DAG administration was not accompanied by many side effects when compared with placebo. CONCLUSIONS DAG administration improves glycemic control in obese subjects with type 2 diabetes through the suppression of AG levels. DAG is a good candidate for the development of compounds in the treatment of metabolic disorders or other conditions with a disturbed AG:DAG ratio, such as type 2 diabetes mellitus or Prader-Willi syndrome.
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Affiliation(s)
- Behiye Özcan
- Department of Internal MedicineErasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, The NetherlandsLilly Research LaboratoriesLilly Corporate Center, Indianapolis, Indiana 46285, USAAlizé Pharma69 130 Ecully, France
| | - Sebastian J C M M Neggers
- Department of Internal MedicineErasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, The NetherlandsLilly Research LaboratoriesLilly Corporate Center, Indianapolis, Indiana 46285, USAAlizé Pharma69 130 Ecully, France
| | - Anne Reifel Miller
- Department of Internal MedicineErasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, The NetherlandsLilly Research LaboratoriesLilly Corporate Center, Indianapolis, Indiana 46285, USAAlizé Pharma69 130 Ecully, France
| | - Hsiu-Chiung Yang
- Department of Internal MedicineErasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, The NetherlandsLilly Research LaboratoriesLilly Corporate Center, Indianapolis, Indiana 46285, USAAlizé Pharma69 130 Ecully, France
| | - Virginia Lucaites
- Department of Internal MedicineErasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, The NetherlandsLilly Research LaboratoriesLilly Corporate Center, Indianapolis, Indiana 46285, USAAlizé Pharma69 130 Ecully, France
| | - Thierry Abribat
- Department of Internal MedicineErasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, The NetherlandsLilly Research LaboratoriesLilly Corporate Center, Indianapolis, Indiana 46285, USAAlizé Pharma69 130 Ecully, France
| | - Soraya Allas
- Department of Internal MedicineErasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, The NetherlandsLilly Research LaboratoriesLilly Corporate Center, Indianapolis, Indiana 46285, USAAlizé Pharma69 130 Ecully, France
| | - Martin Huisman
- Department of Internal MedicineErasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, The NetherlandsLilly Research LaboratoriesLilly Corporate Center, Indianapolis, Indiana 46285, USAAlizé Pharma69 130 Ecully, France
| | - Jenny A Visser
- Department of Internal MedicineErasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, The NetherlandsLilly Research LaboratoriesLilly Corporate Center, Indianapolis, Indiana 46285, USAAlizé Pharma69 130 Ecully, France
| | - Axel P N Themmen
- Department of Internal MedicineErasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, The NetherlandsLilly Research LaboratoriesLilly Corporate Center, Indianapolis, Indiana 46285, USAAlizé Pharma69 130 Ecully, France
| | - Eric J G Sijbrands
- Department of Internal MedicineErasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, The NetherlandsLilly Research LaboratoriesLilly Corporate Center, Indianapolis, Indiana 46285, USAAlizé Pharma69 130 Ecully, France
| | - Patric J D Delhanty
- Department of Internal MedicineErasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, The NetherlandsLilly Research LaboratoriesLilly Corporate Center, Indianapolis, Indiana 46285, USAAlizé Pharma69 130 Ecully, France
| | - Aart Jan van der Lely
- Department of Internal MedicineErasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, The NetherlandsLilly Research LaboratoriesLilly Corporate Center, Indianapolis, Indiana 46285, USAAlizé Pharma69 130 Ecully, France
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Continuous glucose profiles with vildagliptin versus sitagliptin in add-on to metformin: Results from the randomized Optima study. DIABETES & METABOLISM 2012; 38:359-66. [DOI: 10.1016/j.diabet.2012.06.001] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 06/04/2012] [Accepted: 06/04/2012] [Indexed: 01/16/2023]
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Abstract
OBJECTIVE Continuous glucose monitoring (CGM) systems collect and store glucose data in an ongoing fashion for several days at a time. The main advantage of CGM is that it can help identify fluctuations and trends that would otherwise go unnoticed with other glucose measures. Here, we provide a review of CGM for behavioral researchers. METHODS We begin with a brief review of diabetes and glucose measurement and then describe what CGM is and reference the commercial CGM systems currently available. We discuss the challenges involved in using CGM in behavioral research. We then present a broad overview of CGM in behavioral research, including data from ours and others' research programs. Finally, we cover some practical issues to be considered when using CGM, suggest reporting guidelines for the behavioral researcher, and offer suggestions for future research. RESULTS Only a handful of behavioral researchers are using CGM, although its use is increasing. The main ways that CGM is being used in behavioral research is to investigate basic biobehavioral processes, to assess the effects of behavioral interventions on diabetes control, and to use CGM itself as a behavior modification and teaching tool in diabetes self-management interventions. CONCLUSIONS Continuous glucose monitoring holds promise to help behavioral researchers unravel the complex relationships among glucose and intrapersonal, interpersonal, and contextual factors. However, the uptake of CGM for this purpose is limited, and the possibilities for its use are largely unmet. We encourage behavioral researchers to implement CGM in their protocols and to do so in a way that maximizes its explanatory power.
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Seizure in a diabetic patient. Hypoglycemia or a side effect of continuous glucose monitoring? ACTA ACUST UNITED AC 2011; 59:144-6. [PMID: 22055803 DOI: 10.1016/j.endonu.2011.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 06/14/2011] [Accepted: 06/20/2011] [Indexed: 11/21/2022]
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Thielen V, Scheen A, Bringer J, Renard E. Attempt to improve glucose control in type 2 diabetic patients by education about real-time glucose monitoring. DIABETES & METABOLISM 2010; 36:240-3. [DOI: 10.1016/j.diabet.2010.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 03/15/2010] [Accepted: 03/18/2010] [Indexed: 11/30/2022]
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Sanchez I. The use of continuous glucose monitoring system in the home health setting. HOME HEALTHCARE NURSE 2010; 28:291-297. [PMID: 20463512 DOI: 10.1097/nhh.0b013e3181dbf063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Unger J, Parkin CG. Appropriate, timely, and rational treatment of type 2 diabetes mellitus: Meeting the challenges of primary care. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/s1557-0843(09)80029-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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